Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
BMJ Open. 2021 Jan 31;11(1):e044163. doi: 10.1136/bmjopen-2020-044163.
Some studies have identified tumour-infiltrating lymphocytes (TILs) in H&E-stained sections of gastric cancer, but the prognostic and clinicopathological significance of this remains unclear. The objective of this study is to evaluate the associations between H&E-based TIL density and prognosis and clinicopathological characteristics of patients with gastric cancer.
Systematic review and meta-analysis.
Cochrane Library, PubMed and Embase databases were searched through 25 February 2020.
Studies evaluating the correlations between TILs assessed by H&E-stained sections and prognosis and clinicopathological characteristics of gastric cancer were included.
Relevant data were extracted and risks of bias were assessed independently by two reviewers. HR and relative risk (RR) with 95% CI were pooled by random-effect models to estimate the associations between TIL density and overall survival (OS) and clinicopathological characteristics, respectively.
We enrolled nine studies including 2835 cases for the present meta-analysis. High TILs were associated with superior OS (HR=0.68, 95% CI 0.52 to 0.87, p=0.003) compared with low TILs. High TILs were significantly associated with lower depth of invasion (T3-T4 vs T1-T2) (RR=0.58, 95% CI 0.50 to 0.66, p<0.001), less lymph node involvement (presence vs absence) (RR=0.68, 95% CI 0.56 to 0.81, p<0.001) and earlier TNM (tumour, node, metastasis) stage (III-IV vs I-II) (RR=0.68, 95% CI 0.55 to 0.83, p<0.001). TIL density was not associated with age, gender, Lauren classification or histological grade. The methodology for evaluating TIL and its cut-off value varied across different studies, which might affect the results of our meta-analysis.
Our meta-analysis suggests that H&E-based TIL density is a reliable biomarker to predict the clinical outcomes of patients with gastric cancer. Multicentre, prospective studies are needed to further confirm our findings.
CRD42020169877.
一些研究已经在胃癌的 H&E 染色切片中发现了肿瘤浸润淋巴细胞（TILs），但其预后和临床病理意义尚不清楚。本研究旨在评估基于 H&E 的 TIL 密度与胃癌患者预后和临床病理特征之间的相关性。
系统综述和荟萃分析。
通过 Cochrane 图书馆、PubMed 和 Embase 数据库检索，检索截至 2020 年 2 月 25 日。
纳入评估 H&E 染色切片中 TILs 与胃癌患者预后和临床病理特征相关性的研究。
由两名独立评审员提取相关数据并评估偏倚风险。通过随机效应模型对 HR 和相对风险（RR）及其 95%CI 进行合并，以分别估计 TIL 密度与总生存期（OS）和临床病理特征之间的相关性。
本荟萃分析纳入了 9 项研究，共 2835 例患者。与低 TIL 相比，高 TIL 与更好的 OS（HR=0.68，95%CI 0.52 至 0.87，p=0.003）相关。高 TIL 与肿瘤浸润深度较浅（T3-T4 与 T1-T2）（RR=0.58，95%CI 0.50 至 0.66，p<0.001）、淋巴结受累较少（存在与不存在）（RR=0.68，95%CI 0.56 至 0.81，p<0.001）和更早期的 TNM（肿瘤、淋巴结、转移）分期（III-IV 与 I-II）（RR=0.68，95%CI 0.55 至 0.83，p<0.001）显著相关。TIL 密度与年龄、性别、Lauren 分类或组织学分级无关。不同研究评估 TIL 的方法及其截断值不同，这可能会影响我们荟萃分析的结果。
本荟萃分析表明，基于 H&E 的 TIL 密度是预测胃癌患者临床结局的可靠生物标志物。需要进行多中心、前瞻性研究以进一步证实我们的发现。
PROSPERO 注册号：CRD42020169877。
